AccountId: 011433970860
ContactId: 4a0094cc-768b-4bcb-953c-d0cac8c54594
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 169479 ms
Total Talk Time (AGENT): 72279 ms
Total Talk Time (CUSTOMER): 69898 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/4a0094cc-768b-4bcb-953c-d0cac8c54594_20250221T16:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII]. I'm calling from Nicholas Children's Hospital. Um, I'm calling to verify benefits and eligibility for a patient that is here for a couple of diagnostic services.
[AGENT][POSITIVE] Alright, I'm happy to check on benefits and eligibility today. Do you have their policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, the policy number here is 02494835.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][POSITIVE] Alright thank you so much let me pull this up here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And if I can get patient's name and date of birth please?
[CUSTOMER][NEUTRAL] Yeah. Patient name is [PII]. Last name [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. So patient plan is active. The effective date is [PII]. We're the members secondary insurance, so this is gonna cover deductible, co-pay, and co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK, cover deductible, co-pay, coinsurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is there, um, an amount that's allotted each year for the patient, or is this?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Alright, so this member plan looks like their outpatient benefit max is a calendar day and that's $750.
[CUSTOMER][NEUTRAL] OK, so outpatient benefit max is 750 per day.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then beyond the 750, that'll be taken by, uh, taken care of by the primary insurance?
[CUSTOMER][NEUTRAL] Or how?
[AGENT][NEUTRAL] No, no, no, so this picks up anything the primary doesn't, so yeah, yeah, we would be the, the last to bill.
[CUSTOMER][NEUTRAL] It doesn't, OK.
[CUSTOMER][POSITIVE] OK, perfect. Yeah.
[CUSTOMER][POSITIVE] Perfect. OK, and then.
[CUSTOMER][NEUTRAL] OK perfect and then may I please get a call reference ID?
[AGENT][NEUTRAL] Yeah, absolutely. Call references my name with my last initial and then today's date. My name again is [PII], that's [PII] My last initial to my name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so [PII] and then today's date?
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help. I really appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Alright have a good day. Thank you you too.